News in brief: Psoriasis flares not a barrier to ICI treatment; Home chemo proves safe during pandemic; Improved prediction of PICC thrombosis in cancer patients

Thursday, 14 Oct 2021

Psoriasis not a barrier to ICI treatment

Flares of pre-existing psoriasis are fairly common in patients treated with immune checkpoint inhibitors for a range of cancers including melanoma.

A study of 76 ICI-treated patients from the US, Australian and Germany found 57% experienced a flare of cutaneous or extracutaneous disease such as arthritis or iritis.

Most psoriasis flares were grade 1 or 2 and resolved with topical therapies including corticosteroids, calcipotriol, and phototherapy.

“While cutaneous exacerbation was relatively manageable, arthritis flares more commonly required systemic immunosuppression, with five of six patients requiring prednisone, which may impact treatment decisions in patients with extracutaneous disease at baseline.”

Only five patients (7%) required ICI discontinuation.

“While it may require additional multidisciplinary management, these data indicate that psoriasis should not generally preclude treatment of advanced melanoma with immunotherapy.”

Read more in the Journal for ImmunoTherapy of Cancer

At-home cancer treatment during COVID-19 was safe

COVID-19 has driven increased uptake of home-delivered cancer therapies – a trend which is unlikely to shift back post-pandemic.

A Letter to the Editor in Australian Health Review said the experience at the Central Adelaide Local Health Network was that home chemotherapy delivery was a safe alternative to hospital-based administration and should be considered for further utilisation.

The authors said 600 home visits for cancer services were delivered during April-July 2020 with no unexpected adverse events and only a single safety incident.

“To provide this service [email protected] were required to significantly increase staffing to process admissions and perform home visits, as well as secure additional equipment, vehicles, and telecommunication devices,” they said.

They said the particular benefit during the COVID-19 pandemic was to protect people vulnerable to infection.

“Additional benefits to home chemotherapy administration came to light during this period of increased utilisation, including the safety of relative isolation at home, reduced patient transport needs and associated expenses, higher levels of patient support and education, and reduced patient and visitor traffic in hospitals.”

“With appropriate clinical governance, specialist oversight, training and accreditation, home chemotherapy administration should expand further and will likely become part of standard clinical practice, even after the COVID-19 pandemic concludes.”

Improved prediction of PICC thrombosis in cancer patients

Patients with active cancer have longer peripherally inserted central catheter (PICC) durations (70 v 18 days) and higher PICC thrombosis rates than patients without cancer (7% vs 0.7%).

The Australian findings, from a retrospective single centre case-control audit of 249 participants, confirm PICC thrombosis in cancer patients as an area of clinical need.

The study also evaluated the utility of the Khorana risk score (KRS) which predicts VTE in cancer and the Michigan Risk Score (MRS) specific for PICC thrombosis.

It found that adding thrombocytosis to the MRS improved its ability to predict PICC thrombosis (AUC 0.72) – resulting in a low risk group comprising 48% of cancer patients with a low rate of PICC thrombosis (1.4%).

“Prospective validation of this modified MRS as a risk assessment model for PICC thrombosis would be invaluable to clinical practice,” the study concluded.

Read more in the Internal Medicine Journal

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